Am. J. Respir. Crit. Care Med.,
Volume 164, Number 8, October 2001, 1514-1518
Diffuse Alveolar Damage after Exposure to an
Oil Fly Ash
ANDREW J.
GHIO,
JACK G.
GILBEY,
VICTOR L.
ROGGLI,
JUDY H.
RICHARDS,
JOHN K.
MCGEE,
JOHNNY L.
CARSON,
ROBERT B.
DEVLIN,
and
WAYNE E.
CASCIO
National Health and Environmental Effects Research Laboratory, Environmental Protection Agency, Research Triangle Park, North Carolina;
Pathology Department, Duke University Medical Center, Durham, North Carolina; and Department of Internal Medicine and Department of
Pediatrics and the Center for Environmental Medicine and Lung Biology, University of North Carolina, Chapel Hill, North Carolina
Epidemiological investigation has established an association between exposure to particulate matter (PM) and both human mortality and diverse indices of human morbidity. However, attributing adverse health effects of specific individuals to PM exposure in
these studies is not possible. Consequently, their clinical presentation remains ill-defined. We describe a 42-yr-old male with both
respiratory damage, abnormal blood end points, and cardiac effects following an exposure to an emission source air pollution
particle aersolized during the cleaning of his domestic oil-burning
stove. Early symptoms of shortness of breath and wheezing progressed over 2 wk to hypoxic respiratory failure necessitating mechanical ventilation. Blood indices were abnormal. Thoracoscopic
biopsy demonstrated particle-laden macrophages and diffuse alveolar damage. Symptomatic and objective improvement rapidly
followed initiation of corticosteroids. He developed typical anginal
symptoms within 2 wk of discharge; however, coronary angiography
did not identify any significant narrowing of the epicardial coronary
arteries. This patient presents with the aggregate of potential injuries described by epidemiological methods to be associated with
air pollution particle exposure.
